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STILL TECHNIQUE FORCOMMON COUNTERSTRAIN
TENDER POINTS
KELLEY JOY, DO
CLINICAL ASSOCIATE PROFESSOR
OSTEOPATHIC MANIPULATIVE MEDICINE
KCU – JOPLIN CAMPUS
COUNTERSTRAIN HISTORY
• Lawrence “Larry” Jones, DO
• 1955 Posterior tender points
• Anterior tender points
• 1964 “Spontaneous Release by Positioning”
• 1980 Strain and Counterstrain
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COUNTERSTRAIN DEFINITION
• A system of diagnosis and treatment developed by
Lawrence Jones, DO that considers the dysfunction
to be a continuing, inappropriate strain reflex, which
is inhibited by applying a position of mild strain in
the direction exactly opposite to that of the false
strain reflex; this is accomplished by the use of the
specific point of tenderness related to this
dysfunction followed by specific directed positioning
to achieve the desired therapeutic response.
STILL TECHNIQUE HISTORY
• A.T. Still, MD, DO, Visionary
• Anatomy, Anatomy, Anatomy – Then fix it!
• Still Technique lost – easier to teach HV/LA
• Still Technique “Rediscovered” by Richard Van
Buskirk
• Reading Charles Hazzard, DO
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STILL TECHNIQUE DEFINITION
• Characterized as a specific, non-repetitive
articulatory method that is indirect, then direct.
STILL TECHNIQUE VIDEO
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CERVICAL REGION
• Trapezius
• Rectus Capitis Posterior/Superior
• Splenius Capitis
• Scalenes
Posterior
Anterior
CERVICAL POSTERIOR
Trapezius
Splenius
capitus
Rectus capitis
posterior minor
Splenius
capitus
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TRAPEZIUS 1. Place sensing finger at the trapezius
origin at the base of the occiput
2. Lift the head and introduce traction
3. Slightly extend the head
4. Maintaining traction force, move
the head into flexion, sidebending
away from tender point
5. Remove traction and return to
neutral
6. Reassess
Bonus: Also treats semispinalis capitus
RECTUS CAPITIS1. Index or middle fingers are placed
below the basiocciput
2. Flex the basiocciput until relaxation
is felt under the fingers
3. Induce traction toward the area of
the posterior foramen magnum
4. Maintaining traction, extend the
occiput posteriorly around the
fingers
5. Remove traction.
6. Reassess.
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SPLENIUS CAPITIS1. Sensing finger is posterior and
medial to the mastoid body
2. Operating hand cups the inion
3. Extend the head, sidebending
toward the tender point and
rotating away
4. Induce traction and move the
head and neck into flexion,
then rotate the head toward
the tender point
5. Release traction and return to
neutral
6. Reassess
Middle scalene
Anterior scalene
CERVICAL ANTERIOR
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MIDDLE SCALENE1. Sensing finger is placed on
the posterior lateral shaft of
the first rib
2. Sidebend head and neck
toward the tender point
3. Operating hand compresses
toward the tender point
4. Sidebend the head and neck
away from the tender point
5. Return the head and neck to
neutral
6. Reassess.
UPPER EXTREMITY REGION
• Levator Scapula
• Supraspinatus
• Biceps tendon
• Pectoralis minor
• Rhomboid
• Carpal Tunnel Release
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UPPER EXTREMITY - POSTERIOR
Levator scapula
Supraspinatu
s
Pectoralis Minor
Biceps
Long Head
Short HeadRhomboid
Flexor Retinaculum
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LEVATOR SCAPULA 1. Abduct ipsilateral arm, flex the elbow.
2. Sensing finger is placed over the
superior medial border of the scapula.
3. Operating hand cups the upper neck
and basiocciput.
4. Rotate the patients head and neck
away from the tender point. Extend
the neck and slightly sidebend toward
the tender point.
5. Introduce traction and move the
patient’s neck into flexion, sidebending
away, rotation toward the tender point.
6. Release traction and return to neutral.
7. Reassess.
SUPRASPINATUS 1. Sensing hand stabilizes the acromion
with a finger on the supraspinatus.
2. Operating hand is on the elbow of the
affected side.
3. Position the elbow at full shoulder
abduction.
4. Introduce compression from the elbow
to the supraspinatus muscle belly.
5. Take the arm inferiorly across the body
into abduction (elbow should be near
the umbilicus).
6. Release compression and return to
neutral.
7. Reassess.
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BICEPS TENDON 1. Sensing finger is placed on the
bicipital notch.
2. Operating hand is on the
forearm of the affected side.
3. Adduct the arm, flex the elbow.
4. Introduce traction.
5. Abduct the shoulder and
extend the elbow.
6. Release traction and return to
neutral.
7. Reassess.
PECTORALIS MINOR 1. Sensing finger is placed on the
coracoid process.
2. Operating hand encircles the
patient’s forearm.
3. Arm is slightly flexed, then
adducted.
4. Compress toward the coracoid.
5. Flex the arm, placing the elbow
near the ear.
6. Release compression and return
to neutral.
7. Reassess.
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RHOMBOID 1. Sensing hand is on the rhomboid
tender point. The rest of the hand
stabilizes the shoulder.
2. Operating hand is on the ipsilateral
elbow.
3. Extend the arm with the elbow
flexed.
4. Introduce compression toward the
rhomboid.
5. Flex and abduct the arm.
6. Release compression and return to
neutral.
7 Reassess
CARPAL TUNNEL 1. Both hands will be operating hands.
2. Grasp the patient’s thenar and
hypothenar eminences with your
thumbs on the palmar surfaces.
3. Fold the eminences toward the
palmar midline.
4. Introduce compression from both
hands toward the carpal tunnel.
5. Simultaneously externally rotate the
thenar and hypothenar eminences.
6. Release compression and return to
neutral.
7. Reassess.
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LOW BACK & PELVIS REGION
• Quadratus lumborum
• Psoas
• Gluteus medius
• Piriformis
LOWER BACK REGION
Piriformis
Gluteus medius
Psoas
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Gluteus medius
Piriformis
Psoas
PSOAS 1. Sensing hand is on the transverse
process of L2, the remainder of the
hand stabilizes the lower spine an
upper pelvis.
2. Operating hand is placed on the
flexed knee.
3. Introduce compression through the
patient’s knee toward the sensing
finger.
4. Bring the knee posteriorly and
inferiorly with mild abduction, taking
the hip into extension.
5. Release compression and return to
neutral
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GLUTEUS MEDIUS 1. Sensing hand is placed under the patient at
the gluteus medius tender point.
2. Operating hand 1 (caudal) is placed at the
ankle.
3. Hip is flexed to ~100 degrees and adducted
with slight external rotation.
4. Sensing hand is placed on the knee and
becomes operating hand 2.
5. Compression through the knee toward the
gluteus medius.
a. Bring the ankle laterally, inducing internal
rotation.
b. Abduct the knee to about 60 degrees.
c. Extend the patient’s knee.
6. Remove compression and return to neutral.
PIRIFORMIS1. Sensing finger is at the tender point on the
piriformis.
2. Caudal hand grasps the ankle.
3. Flex, abduct, and externally rotate the hip.
4. Place the cephalad hand on the knee.
5. Introduce compression toward the piriformis.
1. Leading with the ankle, induce adduction.
2. When the hip is fully adducted, internally rotate
by abducting the ankle.
3. Extend the knee toward neutral.
6. Remove compression when the knee is at 45
degrees and return to neutral.
7. Reassess.
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LOWER EXTREMITY REGION
Tibialis AnteriorIliotibia
l Band
LOWER EXTREMITY REGION
• Iliotibial band
• Tibialis anterior
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ILIOTIBIAL BAND 1. Sensing finger on the tender point of
the iliotibial band
2. Operating hand grasps the ipsilateral
ankle.
3. Abduct the leg until tenderness
under the hand is diminished to
<70%.
4. Introduce compression toward the
tender point.
5. Adduct the leg to slightly past
midline, adding slight flexion of the
knee.
6. Release compression and return to
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TIBIALIS ANTERIOR 1. Sensing finger is on the origin
of the Tibialis anterior.
2. Operating hand grasps the
patient’s foot.
3. Place the patient’s foot in
supination and dorsiflexion.
4. Introduce compression
towards the sensing finger.
5. Move the patient’s foot into
pronation and plantar flexion.
6. Release compression and
return to neutral.
7. Reassess.
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REFERENCES
• Nicholas, Alexander and Nicholas, Evan. Atlas of
Osteopathic Techniques, 3rd Edition. Wolters Kluwer.
2016.
• Gilroy, MacPherson, Ross, Schunke, Schulte,
Schumacher, Baker. Gilroy Atlas of Anatomy, 3rd
Edition. Thieme Medical Publishers, Inc. 2018.
• Van Buskirk, Richard L, DO, PhD, FAAO. The Still Technique Manual. Fall, 2016.
THANK YOU
•Thank you to my daughter,
Rose, and my husband, Micah
for help with the pictures.